Author + information
- Elad Asher,
- Perry Anarado,
- Myttle Mayuga,
- Martin Bradley,
- Ka Chun Alan Chan,
- Isidore Okere,
- Darwin Jeyaraj,
- Daniel Simon and
- Tom Lassar
Multiple trials suggest that high residual on-treatment platelet reactivity (HRPR) [Platelet Reactivity Units (PRU) ≥230] increases the incidence of major adverse cardiac events: death, myocardial infarction, target vessel revascularization and stent thrombosis (MACE). Data on routine real world testing is lacking
581 patients had PCI [371 acute coronary syndromes (ACS), 210 non-ACS] and platelet function testing after initial background aspirin and ≥ 600 mg of clopidogrel. For PRU at 12–24 hours < 230, maintenance 325 mg/day of aspirin and 75 or 150 mg/day of clopidogrel for 1 week then 75 mg/day were continued unless followup testing at 1–3 weeks demonstrated HRPR. Most patients with initial HRPR were switched to prasugrel or ticagrelor with no further testing, as hyporesponse is rare; or clopidogrel 150 mg/day with repeat testing at 1–3 weeks. Continued HRPR on clopidogrel usually drove switching to prasugrel or ticagrelor unless contraindicated.
There were 225 (39%) HRPR (148 ACS vs. 77 non-ACS) and 356 (61%) responders (223 ACS vs. 133 non-ACS). MACE was similar between the two groups [7/225 (3.1%) vs. 6/356 (1.7%), respectively, p=0.27]. MACE for ACS patients was also similar between the two groups [5/148 (3.4%) vs. 6/223 (2.7%), respectively, p=0.76]. Even after subdividing ACS to unstable angina (UA) and Non ST elevation MI (NSTEMI) vs. ST elevation MI (STEMI) MACE was similar for HRPR and responders [4/113 (3.5%) vs. 6/163 (3.7%), respectively, p=NS, for UA/NSTEMI and 1/35 (2.8%) vs. 2/60 (3.3%), respectively, p=NS, for STEMI]. The 30 day incidence of stent thrombosis was only 1 in the HRPR group and was related to medication noncompliance.
Adjusting anti-platelet therapy for ACS and non ACS patients, on the basis of VerifyNow testing results in low and equivalent MACE at 30 days after PCI, for initial anti-platelet responders and HRPR patients switched to more effective therapy.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: ACS Therapy: Antiplatelet Agents
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1129-202
- 2013 American College of Cardiology Foundation